Acne vulgaris is a common self limited disorder of the pilosebaceous unit of the skin which usually is characterized by comedones, papules, pustules and nodules on the face, chest and back. Acne vulgaris affects both males and females. The greatest numbers of cases are seen in adolescents and teenagers. Most garden varieties of acne vulgaris are reasonably well treated and controlled with a variety of topical therapies as well as orally administered antibiotics. However, there are more uncommon severe acne variants that are much more difficult to treat. These are principally nodulocystic acne vulgaris and acne conglobata. Nodulocystic acne affects both males and females, and along with acne comedones, papules, and pustules, is accompanied by a number of inflammatory acne nodules and cysts. Acne conglobata (also known as conglobate acne) is the rare, but most severe form of acne, which is found predominately in males. In acne conglobata lesions usually occur on most of the face, trunk and limbs. Nodules are characteristic and frequently fuse to form multiple draining sinuses which may discharge a foul-smelling material. Healing results in extreme scarring, and acne conglobata is often much more persistent then other forms of acne. Treatment of these severe acne variants has been primarily limited to orally administered isotretinoin, but the popularity of this mode of therapy has significantly diminished of late due to a variety of serious systemic side effects associated with its usage. Consequently, there is a great medical need for a safe and effective treatment for these types of severe acne.
Over the last decade, agents which are selective inhibitors of either or both type 1 or type 2 isoforms of steroid 5α-reductase (5AR), an intracellular enzyme that converts testosterone to the much more potent 5α-dihydrotestosterone (DHT), have been widely utilized to treat symptomatic benign prostatic hyperplasia (BPH) in men with enlarged prostate glands. More recently the regular use of such selective inhibitors of 5AR has been advocated to prevent development of cancer of the prostate or to shrink aggressive prostatic tumors. These drugs have not been used in younger males.